Postmortem Findings in Patient with Guillain-Barré Syndrome and Zika Virus Infection

Abstract

Postmortem examination results of a patient with Guillain-Barré syndrome and confirmed Zika virus infection revealed demyelination of the sciatic and cranial IV nerves, providing evidence of the acute demyelinating inflammatory polyneuropathy Guillain-Barré syndrome variant. Lack of evidence of Zika virus in nervous tissue suggests that pathophysiology was antibody mediated without neurotropism.

Keywords: Guillain-Barré syndrome; Puerto Rico; Zika virus; infectious disease pathophysiology; postmortem investigation; vector-borne infections; viruses.

Figure 1

Timeline of key events surrounding the illness of a patient with GBS and confirmed Zika virus infection, Puerto Rico, 2016. AIDP, acute inflammatory demyelinating polyneuropathy; CT, computed tomography; ED, emergency department; GBS, Guillain-Barré syndrome; ICU, intensive care unit.

Figure 2

Histopathologic evaluation of tissue specimens collected postmortem from a patient with Guillain-Barré syndrome (acute demyelinating inflammatory polyneuropathy variant) and Zika virus infection, Puerto Rico, 2016. A, B) Luxol fast blue-periodic acid-Schiff myelin stain of sciatic nerves show patchy myelin loss and variable inflammation. Original magnification x10(A) and x20(B). C) Detection of CD68–positive cells (microphages) by immunohistochemistry (arrows) in sciatic nerve. Original magnification x20. D) Hematoxylin and eosin stain of cranial nerve IV shows perivascular lymphocytic infiltrate. Original magnification x20. E) Detection of T-lymphocytes by immunohistochemistry (arrows) in the same area where lymphocytic infiltrates were observed by hematoxylin and eosin stain. Original magnification x40.